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Taking Issue | August 01, 2008

An Orphan Comes of Age

Benjamin G. Druss

Psychiatric Services 2008; doi: 10.1176/appi.ps.59.8.833

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As a postdoctoral fellow in the mid-1990s, I attended a session at the American Psychiatric Association's annual meeting at which the presenter discussed psychiatrists' role in ensuring that their patients receive primary medical care. I looked around the room and saw three other psychiatrists in the large and otherwise empty auditorium. After the talk, I went up to the podium and asked the speaker why he thought that so few people had attended. He said he supposed that general medical topics made mental health providers uncomfortable and that persons with serious mental illness made primary care providers uncomfortable. The topic, he said, was an orphan that had yet to find a home.

What a difference a decade makes. The topic of general medical care for persons with mental illnesses has moved into the mainstream of research and policy efforts in the United States and abroad. Accumulating evidence has documented high rates of medical comorbidity and premature death in this population. Even more troubling is the evidence that we mental health providers are partly complicit in this excess morbidity and mortality. We are guilty both of sins of omission, through our failure to focus on our clients' physical health care needs, and commission, through the iatrogenic effects of psychotropic agents that we use to treat psychiatric symptoms.

As this evidence has accumulated, a broad and diverse range of stakeholders, including state mental health program directors, consumer groups, community mental health organizations, and federal agencies, have begun to address the problem of medical morbidity and mortality among mental health care consumers. The Center for Mental Health Services is currently spearheading the "Ten by Ten" campaign, which aims to reduce the disparity in life expectancy for persons with serious mental illness by ten years (from 25 years to 15 years) within the next ten years.

Many of the most important studies in this emerging area have been published in Psychiatric Services. In this issue the journal continues its leading role in drawing attention to this topic, featuring studies that document the burden of comorbid mental and medical illnesses, the problems in access to and quality of medical care for persons with serious mental illnesses, and the challenges that systems of care face when they seek to address these problems. Now that this orphan topic has been adopted by policy makers and advocates, these new studies have an even greater opportunity to help drive national efforts to improve health and health care for mental health consumers.

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Benjamin Druss, M.D., M.P.H.; An Orphan Comes of Age. Psychiatric Services. 2008 Aug;59(8):833-833.

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